Protective Orders Not a Qualifying Event Under
COBRA

July 18, 2005 (PLANSPONSOR.com) - A protective order
against a health plan participant's estranged husband was not
the same as a legal separation agreement and therefore was
not a qualifying event for continued coverage under COBRA, an
appeals court has ruled.

District Judge Bobby Baldock of the US Court of
Appeals for the Tenth Circuit upheld a lower court ruling
for Zeda Simpson that a protective order against her
estranged husband was not the same as a legal separation
agreement and therefore did not trigger the plan
administrator’s obligation to notify the covered
beneficiary of the right to continued coverage under the
Consolidated Omnibus Budget Reconciliation Act
(COBRA).

Simpson was covered under her husband’s health
plan with employer T.D. Williamson Inc (TDW), according to
a BNA report.
In July of 2000, she filed for divorce and a court
issued protective orders for Simpson’s husband to stay
away from her and the marital residence.
Simpson sent a letter to TDW asking them to not disclose
medical information about her to her husband.
TDW considered this letter notice of a qualifying event as
a result of legal separation and notified Simpson of her
right to continued health insurance coverage under COBRA.
Simpson elected coverage, but neither the company nor
Simpson paid the premiums for the coverage.

In June 2002, the employer notified Simpson that her
health coverage was being cancelled due to non-payment of
premiums.
In July of that year, Simpson notified T.D. Williamson that
a final divorce decree had been issued and she wished to
elect COBRA coverage.
The employer told her she could not be reinstated because
her rights had expired.
Simpson filed a case with the US District Court for the
Northern District of Oklahoma.
The court ruled in favor of Simpson and ordered TDW to
provide her health coverage and reimbursement for uninsured
medical expenses and attorney’s fees.

TDW appealed the ruling.
Since COBRA does not define “legal separation”
and there were no appeals court precedents, Baldock relied
on an immigration case in which the legal separation was
defined as a judicial alteration of the marriage. In his
opinion, cited by BNA, Baldock, said that “a decree of
legal separation directs the parties to live apart and
defines the parties legal rights and obligations in regard
to custody, support, property division and/or
maintenance” without dissolving the marriage bond.
He found that no legal separation occurred and agreed with
the District Court in favor of Simpson.